PATIENT FILE 29 OCT 90

File: 102896_aug96_decls1_0013.txt
Page: 0013
Total Pages: 46

Subject: PATIENT FILE  29 OCT 90                                         

Box ID: BX000482

Unit: ARCENT      

Parent Organization: CENTCOM     

Folder Title: MEDSTAT - SITREPS  OCT 90  3 OF 4                                                               

Folder SEQ  #:         16

Document Number:         10



             06:50:34                                               PATI@ T Fil                                                 io/i@9190
                                                                       @ -N      @E
                                                        PERSONAL DATA - @RIVA@uy ACT OF 1974



                                                                                                                            '3. NO'
                                                             18, AUTHORITY #: 0299AOO@' 2. SSAi%':                          3.  PRECEDENCE: R
      4.  STAT! All               5. GRADE: EO@,             6. AGE-. 7@4Y       7. SEX:               B. ',j'T:  116       9.  READY DATE: 299
      io. ISO.                    11. POR:                                                                                  l@2. SPEC CAT:
      14. READ REG: DS            15. DATE LAST VISIT!                                                                      16. '-'LASS: IC
      17. A'UCEP, PPYS:           JMRO                       5 U.S.C. 552 (b)(6)                                            19, APPT/SURG DATE: NO
      2(i. APPROV AUTP@-                                                         2i. @@As\C/IN'@;                           22. VALID:                 "im    Y7
      2L  M.TF ORTC.                                                                                                            T
                 I . A51-@O       LISA DISPENSARY DHAHRAN                                                                   24  CAD ORIS:      OEDR
      25@ ilTF DEST: A5030        FRANKFURT ARMY REG    ViE'@l                                                              26. ICAG DEST:     C@DAF
      27@ tli@7 SPEC              l@ R.,PPG 28. DIPro 1: 30184 PASSIVE-ACGRESSIVE PERSONALITY
          DIED SPEC 2:            -, @ DIAG 2@
      49.                         -0
      31. M7L SPEC                3: 32@ D@IAS 3;
      2A, PROCED'u'RE@
                                    344 IV:
                                        'T:
      1
      ,5@ 02/LPri:                N' 36@ SUr-      N'   'o7. NS JUBE: N          36. RESP: N                         39, FOLEY:          N     40, STRYKER: N
      41. INCUB:                  N' 42. TRACT: N       43.  IMED: N             44,  P.AST/I,GC: N 1                45. TRACH:          N'    46. MON: N
      71@ PT BAB TYPE-. NB                              72.  PT SAS TAB                                              73. PT BAG 1,4T:
      47. S'UOP it\lg:O: ****DS*** 'n'4B B-158 Ak)N     RES  HANU GERMANY


      48. MAX ENRIE STOPS: Y / 9                        49.  MAX # RONS: Y            9                              50. ALT REST/@iAX HT: %'
      5'0@ INPATIENT: Y           54. SPEC PROS:        VA   DRUG      ALCOHOL        WT     NONE x                  55@ VA CODE@
      56. ADMINIOVERS@@AS@
      58. VITAL SISNS(TE@MP/PL'LSE/RESPIB'@OOD PRESS): 099@2                   50     i9      90       50
      59. HGB:                    60@ HOT:              6@,@ ARG:                                      DATE TAKEN:
      62. 1.4BC!                  63. SI/VSI@           64. MEDIP@IATIONS: NONE




      65. HISTORY: PERSONALITY DISORDER W@lT@@'         POSS PASSIVE AGGR'Cslgi'@'.










      66. AIT PHYS.               YAj 0 CONNOR     67, PH#: 000 000 0000                            66.   WARD4/PH#: 000        000 000 0000
      69. REPORTED BY; GUIDO .451150                                                                70.   PH#: 000 11000
      74@ ATTENDANT NAME #1@                                                                        75.   STATUS:                           76. GRADE:
      77. AGE:                                     78, '-SEX:            78A@ tk'T:                 79,                     TO PATIENT:
      80. BAG TYPE-                                Bi. BAB TAG                                      82.   DAG WT:
                               84.   STATUS:                           85. GRADE:
      86@ AC---i                                   87. SEX@              97A. WT:                   86.   RELATIONSHIP TO PATIENT-.
      69. BAG TYPE:                                90. BAG TAB                                      91.   DAG WT:
      92. TRANS CRIG PHONE                              EXT:
      93. TRANS DEBT PHONE 4@@                          EXT:
      94. ETA DRIG MTF(DATE/TIi4@E): 000                                                            95.   ETA DES-" M@T@r(DATE/TIME)i 000
      97@ OTHER COMMENTS:



      51. NSIN #:                                                                                   52.   RON LOC;
      57. VALIDATED I.;Y/REAS FOR HIGHER PRECEDENCE-.
      96, AIRCRP,@T ITINERARY:

Document 46 f:/Week-32/BX000482/MEDSTAT - SITREPS OCT 90 3 OF 4/patient file 29 oct 90:10019616503417
Control Fields 17
File Room = aug96_declassified
File Cabinet = Week-32
Box ID = BX000482
Unit = ARCENT
Parent Organization = CENTCOM
Folder Title = MEDSTAT - SITREPS OCT 90 3 OF 4
Folder Seq # = 16
Subject = PATIENT FILE 29 OCT 90
Document Seq # = 10
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 01-OCT-1996